Diabetic retinopathy remains one of the leading causes of blindness in the United States. This disease, and its associated visual impairment, represent a major public health problem particularly for African- American diabetic patients among whom the prevalence of diabetes is high with an increasing incidence. In a previous study (The New Jersey 725), we had assembled a large (n=725) cohort of African-Americans with type 1 diabetes, identified from the New Jersey Hospital Discharge Data files. In that study, we delineated frequency of retinopathy and associated visual impairment (which are high, 64% and 11% respectively) as well as identified (in addition to duration of diabetes) three systemic modifiable risk factors, poor glycemic control, systemic hypertension and renal disease significantly associated with the presence and severity of diabetic retinopathy in this group of patients. The overall goal of the present prospective study is to determine the natural history of diabetic retinopathy in African-Americans with type 1 diabetes and examine the relationship between systemic risk factors listed above and progression of the retinopathy so that therapeutic interventions, targeted at these risk factors, can be appropriate designed. In order to achieve oral overall goal, we plan to obtain follow-up examinations of the patients from the previous study to ascertain () the 6-year incidence and progression of diabetic retinopathy (as graded from standard fundus photographs) and associated incidence of visual impairment and (b) how duration of diabetes and systemic risk factors (glycemic control, blood pressure, and renal disease), as measured at the baseline examination, relate to incidence and progression of diabetic retinopathy. Clinical evaluation of patients will include standardized protocols for ocular examination, fundus photography, structured clinical interview, and blood pressure measurement; laboratory evaluation will include blood assays to evaluate glycemic control, insulin insufficiency, and cholesterol levels, and urine assays to assess diabetic renal disease. Results obtained on incidence and progression of diabetic retinopathy and risk factors for disease progression this population group will provide the data to understand the natural history of the disease in African-Americans with type 1 diabetes. Such data are also essential for planning public health education measures, estimating needs for medical services, and designing community-based intervention studies for the prevention of diabetic complications in this group of Americans.